Factors Influencing Lifestyle Modification among Persons with Hypertension in Punakha, Bhutan

Main Article Content

Nima Dorji,RN
Niphawan Samartkit, RN, PhD
Khemaradee Masingboon, RN, DSN


OBJECTIVES: To describe lifestyle modification among persons with hypertension (HT), and examine whether hypertension knowledge, perceived self-efficacy and perceived social support can predict lifestyle modification among persons with HT in Punakha, Bhutan.

MATERIAL AND METHODS: Simple random sampling technique was used to recruit 108 persons with HT visiting the non-communicable disease (NCD) unit of Punakha District Hospital, Bhutan. Data on demographic characteristics and health information were collected using Demographic Questionnaires. Standard instruments such as Hypertension Self-care Profile Behaviour Scale (HBP SCP), Hypertension Knowledge-Level Scale (HK-LS), Hypertension Self-Efficacy Scale and Multidimensional Scale of Perceived Social Support (MSPSS), each bearing reliability coefficient of 0.83, 0.82, 0.81 and 0.85 respectively, were used to measure the research variables. Data was analysed using descriptive statistics and standard multiple regression.

RESULT: The findings showed that lifestyle modification was high among the participants (M = 53.9 ± 7.7). Standard multiple regression revealed hypertension knowledge (β = 0.19, p = 0.04) and perceived self-efficacy (β = 0.36, p < 0.001) as the significant predictors of lifestyle modification. Perceived social support did not predict lifestyle modification. All predictors together explained 21.05% of variance in lifestyle modification (R2 = 21.05%, F(4, 103) = 10.51, p < 0.001) among the participants.

CONCLUSION: The lifestyle modification of persons with HT can be enhanced by designing an intervention directed toward strengthening hypertension knowledge and perceived self-efficacy. While providing the interventional program, healthcare professionals should involve both individual and family to motivate them to promote lifestyle modification.


Download data is not yet available.

Article Details

How to Cite
Dorji,RN N, Samartkit, RN, PhD N, Masingboon, RN, DSN K. Factors Influencing Lifestyle Modification among Persons with Hypertension in Punakha, Bhutan . BKK Med J [Internet]. 2021Jan.14 [cited 2021Apr.23];17(1):1-. Available from: https://he02.tci-thaijo.org/index.php/bkkmedj/article/view/245755
Original Article


1. Chobanian AV, Bakris GL, Black HR, et al. The seventh reportof joint national committee on prevention, detection, evaluation,and treatment of high blood pressure: the JNC7 report. JAMA2003;289(19):2560-71.
2. World Health Organization. Hypertension: Key facts.2019.(Accessed July 31, 2020, at www.who.int/news-room/factsheets/detail/hypertension).
3. GBD 2017 Risk Factor Collaborators. Global, regional, and national comparative risk assessment of 84 behavioral,environmental and occupational, and metabolic risks or clusters of risks for 195 countries and territories,1990-2017:A systematic analysis for the Global Burden of Disease Study 2017. Lancet 2018;392(10159):1995-2051.
4. World Health Organization. The top 10 causes of death. 2018.(Accessed July 31, 2020, at www.who.int/en/news-room/fact-sheets/detail/the-top-10-causes-of-death).
5. Spruill TM, Butler MJ, Thomas SJ, Tajeu GS, Kalinowski J,Castaneda SF, et al. Association between high perceived stress over time and incident hypertension in black adults: findings from the Jackson heart study. J Am Heart Assoc2019;8(21):e012139.
6. Tripathy JP, Thakur JS, Jeet G, et al. Alarmingly high prevalence of hypertension and pre-hypertension in North India-results from a large cross-sectional STEPS survey. PloS One 2017;12(12):e0188619.
7. Yang MH, Kang SY, Lee JA, et al. The effect of lifestyle changes on blood pressure control among hypertensive patients. Korean J Fam Med. 2017;38(4):173-80
8. Alsaigh SAS, Alanazi MD, Alkahtani MA. Lifestyle modifications for hypertension management. Egypt J Hosp 2018;70(12):2152-6.
9. Adidja NM, Agbor VN, Aminde JA, et al. Non-adherence to antihypertensive pharmacotherapy in Buea, Cameroon: A cross-sectional community-based study. BMC Cardiovasc Disord 2018;18(1):150.
10. World Health Organization. Non-communicable disease country profile 2018. 2018. (Accessed July 31, 2020, at https://www.who.int/nmh/countries/en/).
11. National Health Survey [NHS].2012; Thimphu, Bhutan:Ministry of Health
12. Ministry of Health. National survey for non-communicable
disease risk factors and mental health using WHO STEPS approach in Bhutan -2014.2015. (Accessed July 31, 2020, at www.who.int/ncds/surveillance/steps/Bhutan_2014_STEPS_Report.pdf).
13. Wangdi T. Burden, determinants and control of hypertension:A Bhutanese perspective. In Regional Health Forum 2013;17:20-25.
14. Ministry of Health. Annual health bulletin 2019. Thimphu:Tshangpa Printing Press. (Accessed July 31, 2020, at http://www.health.gov.bt/wp-content/uploads/moh-files/2017/06/AHB_2019.pdf).
15. Dorji TC, Dorji R. Living the Bhutanese way. Thimphu: DSB publications; 2005
16. Pelzom D, Isaakidis P, Oo MM, et al. Alarming prevalence and clustering of modifiable noncommunicable disease risk factors among adults in Bhutan: A nationwide cross-sectional community survey. BMC Public Health 2017;17(1):975.
17. Han HR, Lee H, Commodore-Mensah Y, Kim M. Development and validation of the hypertension self-care profile: A practical tool to measure hypertension self-care. J CardiovascNurs 2014;29(3):E11.
18. Whelton PK, Carey RM, Aronow WS, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA /ASH/ASPC/NMA/PCNA
Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J AmColl Cardiol 2018;71(19):e127-e248.
19. Bruno CM, Amaradio MD, Pricoco G, et al. Lifestyle and Hypertension: An Evidence-Based Review. J Hypertens
Manag 2018;4(1):1-0.
20. Santana NMT, Mill JG, Velasquez-Melendez G, et al.Consumption of alcohol and blood pressure: Results of theELSA-Brasil study. PLoS ONE 2018;13(1):1-13.
21. Bhise MD, Patra S. Prevalence and correlates of hypertension in Maharashtra, India: A multilevel analysis. PLoS One 2018;13(2):1-17.
22. Tibebu A, Mengistu D, Negesa L. Adherence to recommended lifestyle modifications and factors associated for hypertensive patients attending chronic follow-up units of selected public hospitals in Addis Ababa, Ethiopia. Patient Prefer Adherence 2017;11:323-30.
23. Giena VP, Thongpat S, Nitirat P. Predictors of health-promoting behaviour among older adults with hypertension in Indonesia.Int J Nurs Sci 2018;5(2):201-5.
24. Buda ES, Hanfore LK, Fite RO, et al. Lifestyle modification practice and associated factors among diagnosed hypertensive patients in selected hospitals, South Ethiopia. Clin Hypertens 2017;23(1):26.
25. Ryan P, Sawin KJ. The individual and family self-management theory: Background and perspectives on context, process, and outcomes. Nurs Outlook 2009;57(4):217-25.
26. Jankowska-Polańska B, Uchmanowicz I, Dudek K, et al. Relationship between patients’ knowledge and medication adherence among patients with hypertension. Patient PreferAdherence 2016;10:2437.
27. Niriayo YL, Ibrahim S, Kassa TD, et al. Practice and predictors
of self-care behaviors among ambulatory patients with hypertension in Ethiopia. PloS One 2019;14(6):e0218947.
28. Akoko BM, Fon PN, Ngu RC, et al. Knowledge of hypertension and compliance with therapy among hypertensive patients in the Bamenda Health District of Cameroon: a cross-sectional study. Cardio Ther 2017;6(1):53-67.
29. Pender NJ, Murdaugh CL, Parsons MN. Health promotion in nursing practice 7th ed. US: Julie Levin Alexander; 2015.
30. Labata BG, Ahmed MB, Mekonen GF, et al. Prevalence and predictors of self-care practices among hypertensive patients at Jimma University Specialized Hospital, Southwest Ethiopia:Cross-sectional study. BMC Res Notes 2019;12(1):86.
31. Ademe S, Aga F, Gela D. Hypertension self-care practice and associated factors among patients in public health facilities of Dessie town, Ethiopia. BMC Health Serv Res 2019;19(1):51.
32. Jandeekaewsakul P, Watthayu N, Suwonnaroop N. Factors predicting self-management behaviors of uncontrollable hypertension patients. Nurs Sci J Thail 2018;36(1):31-43.
33. Fidell LS, Tabachnick BG. Using multivariate statistics 5th ed.2009.
34. Thinley S, Tshering P, Wangmo K, et al. The Kingdom of Bhutan health system review. Mahatma Gandhi Marg, NewDelhi: SEARO Library; 2017.
35. Baliz Erkoc S, Isikli B, Metintas S, et al. Hypertension Knowledge-Level Scale (HK-LS): a study on development,
validity and reliability. Int J Env Res Pub He 2012;9(3):1018-29.
36. Warren-Findlow J, Seymour RB, Huber LR. The association between self-efficacy and hypertension self-care activities among African American adults. J Community Health2012;37(1):15-24.
37. Zimet GD, Dahlem NW, Zimet SG, et al. The multidimensional scale of perceived socialsupport . J Pers Assess1988;52(1),30-41.